右美托咪啶与芬太尼用于清醒气管插管时镇静效果比较

Comparison between dexmedetomidine and fentanyl for sedation during awake tracheal intubation

目的:评价右美托咪啶和芬太尼用于患者清醒气管插管时的镇静效果。方法:本研究选取60例择期骨科手术的老年患者,随机分成两组:研究组患者给予1μg/kg右美托咪啶,对照组患者给予1μg/kg芬太尼。气管插管前对气管黏膜和喉部实施局部麻醉。以呛咳程度评分和插管后耐受程度评分来评价插管条件,记录并比较两组患者的血流动力学、Ramsay镇静评分(RSS)、呼吸频率、低氧例数等情况。术后24h随访对声音嘶哑和咽喉疼痛等进行评估。结果:与对照组相比,研究组患者的呛咳程度评分显著降低,Ramsay镇静评分明显增加,平均动脉压明显降低,发生低氧的患者例数明显减少(P<0.05)。两组患者术后声音嘶哑和咽喉疼痛差异无统计学意义。结论:与芬太尼相比,右美托咪啶能在稳定血流动力学的情况下,为老年患者的清醒气管插管提供足够的镇静效果。

Objective：To evaluate the sedative effect of dexmedetomidine and fentanyl for awake tracheal intubation.Methods：This study was conducted on a total of 60 elderly inpatients scheduled for elective orthopedic surgery, who were randomly divided into two groups.The patients in the experimental group were given dexmedetomidine 1 μg/kg, and the control group was given fentanyl 1 μg/kg.Prior to tracheal intubation, local anesthesia was applied to the trachea mucosa and larynx.The intubation condition was evaluated by the cough severity score and the post-intubation tolerance score.Incidence of hemodynamic changes, Ramsay sedation score, respiratory rate and hypoxic episodes （SpO2〈90 %） were recorded and compared between two groups.At 24-hour follow-up, adverse events such as hoarseness and sore throat were also assessed.Results：Compared with the control group, the cough severity score of the experimental group decreased significantly, the Ramsay sedation score increased significantly, the mean arterial pressure decreased significantly, and the number of hypoxic episodes （O2 saturation 〈90%） decreased significantly （P〈0.05）.There was no significant difference in adverse events （hoarseness and sore throat） between the two groups.Conclusions：Compared with fentanyl, dexmedetomidine can provide adequate sedation for elderly patients with hemodynamic stability during awake tracheal intubation.